Changes on Horizon for Homebound Medicare Beneficiaries

by Admin
(Littleton)

The Centers for Medicare & Medicaid Services is proposing a policy change that would remove a requirement for certain homebound Medicare beneficiaries and is recommending a new payment rate for home health agencies (HHA) for 2015.

Currently, a Medicare beneficiary must have a “face-to-face encounter” with a doctor before that doctor can certify that the patient is homebound and needs skilled care, as outlined in the Affordable Care Act. A detailed description from the doctor also has been required to explain the patient’s need for skilled services. The CMS is proposing to eliminate the need for the detailed narrative although a physician still would need to certify that a face-to-face encounter occurred.

The face-to-face requirement was enacted in part to discourage physicians certifying patient eligibility for the Medicare home health benefit from relying solely on information provided by the HHAs when making eligibility determinations about patient care, according to the CMS document announcing the proposed rule. The CMS received an outpouring of concern from the home health industry saying the documentation requirements lacked established standards for compliance.

In the proposed rule, CMS also has proposed reducing Medicare payments to home health agencies in 2015 by 0.3 percent, affecting approximately 3.5 million beneficiaries.

CMS says the $58 million decrease to the Medicare home health prospective payment system would foster “greater efficiency, flexibility, payment accuracy and improved quality.” The proposed drop reflects the effects of the 2.2 percent home health payment update percentage ($427 million increase) and the adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates and the non-routine medical supplies conversion factor ($485 million decrease).